摘要
目的 探讨抗磷脂酶A2受体（PLA2R）抗体对特发性膜性肾病（IMN）的诊断和病情活动监测价值.方法 选择2012年1月至2014年3月北京协和医院行肾活检并确诊的IMN 233例,以同期46例非IMN肾脏疾病为对照,采用定量ELISA检测肾活检时血清抗PLA2R抗体滴度.绘制抗PLA2R抗体诊断IMN的ROC曲线.结果 抗PLA2R抗体在IMN中总敏感性为60.0％,特异性为100.0％,检测前未行免疫抑制治疗者的阳性率为71.3％,其中25例狼疮性肾炎患者抗体均阴性.肾病范畴蛋白尿者抗体阳性率为68.3％,非肾病范畴蛋白尿者抗体阳性率为41.7％（P＜0.05）;血白蛋白低于30 g/L者抗体阳性率为67.3％,高于血白蛋白＞30 g/L者（44.6％;P＜0.05）.抗体滴度水平越高,则低白蛋白血症越严重（P＜0.05）,肾病范畴蛋白尿的比例越高（P＜0.05）.抗PLA2R抗体诊断IMN的AUCRoc为0.800.结论 抗PLA2R抗体对IMN诊断具有较高的敏感性和特异性,诊断准确性良好.抗体阳性率受免疫抑制治疗、病情活动等因素影响.抗PLA2R抗体可反映IMN的活动性.
Objective To explore the value of anti-phospholipase A2 receptor （PLA2R） antibody in the diagnosis and disease activity monitoring of idiopathic membranous nephropathy （IMN）.Methods A total of 233 patients with IMN proven by kidney biopsy at Peking Union Medical College Hospital from January 2012 to March 2014 were enrolled in this study.Another 46 patients with non-IMN kidney diseases at the same period were selected as control group.Serum titer of anti-PLA2R antibody was measured by quantitative enzyme-linked immuno sorbent assay （ELISA） at the time of renal biopsy.Clinical data were reviewed and retrospectively analyzed.The diagnostic accuracy of anti-PLA2R antibody in IMN was estimated by ROC curve.Results The total sensitivity of anti-PLA2R antibody was 60.0% in IMN.However,the sensitivity increased to 71.3% in patients who did not receive immuno-suppression therapies.The specificity of anti-PLA2R antibody was 100.0%,of which was not detected in any of the 25 control patients with lupus nephritis.The area under ROC curve of anti-PLA2R antibody for IMN diagnosis was 0.800.The prevalence of positive anti-PLA2R antibody in nephrotic range proteinuria group and non-nephrotic range proteinuria group were 68.3% and 41.7% （P 〈 0.05）,respectively.The positive rates in patients with serum albumin level less than 30 g/L and more than 30 g/L were 67.3% and 44.6% （P 〈 0.05）,respectively.Hypoalbuminemia became worse （P 〈 0.05） and the proportion of nephrotic arrange proteinuria rose significantly（P 〈 0.05） according to the elevation of antibody level.Conclusions Anti-PLA2R antibody has high sensitivity and notable specificity for the diagnosis of IMN,which reveals good diagnostic accuracy.The antibody positive rate is affected by immunosuppression therapy,disease activity and other clinical status.Moreover,the antibody could reflect the disease activity.
出处
《中华内科杂志》
CAS
CSCD
北大核心
2015年第9期783-788,共6页
Chinese Journal of Internal Medicine
关键词
肾小球肾炎
膜性
抗磷脂酶A2受体抗体
酶联免疫吸附测定
Glomerulonephritis,membranous
Anti-phospholipase A2 receptor antibody
Enzyme-linked immunosorbent assay
